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Bilateral Glaucomatous Optic Neuropathy Caused by Eye Rubbing.

Savastano A, Savastano MC, Carlomusto L, Savastano S - Case Rep Ophthalmol (2015)

Bottom Line: Over a 4-year observational period, his visual acuity decreased to 12/20 in the right eye and counting fingers in the left eye.Visual fields were severely compromised, and intraocular pressure values were not superior to 14 mm Hg during routine examinations.In fact, our patient strongly rubbed his eyes for more than 10 h per day.

View Article: PubMed Central - PubMed

Affiliation: Western Eye Hospital, Imperial College, London, UK.

ABSTRACT
In this report, we describe a particular condition of a 52-year-old man who showed advanced bilateral glaucomatous-like optic disc damage, even though the intraocular pressure resulted normal during all examinations performed. Visual field test, steady-state pattern electroretinogram, retinal nerve fiber layer and retinal tomographic evaluations were performed to evaluate the optic disc damage. Over a 4-year observational period, his visual acuity decreased to 12/20 in the right eye and counting fingers in the left eye. Visual fields were severely compromised, and intraocular pressure values were not superior to 14 mm Hg during routine examinations. An accurate anamnesis and the suspicion of this disease represent a crucial aspect to establish the correct diagnosis. In fact, our patient strongly rubbed his eyes for more than 10 h per day. Recurrent and continuous eye rubbing can induce progressive optic neuropathy, causing severe visual field damage similar to the pathology of advanced glaucoma.

No MeSH data available.


Related in: MedlinePlus

Visual field showing diffuse defects with focal central conservation in the RE (a) and total visual field deficit in the LE (b). c, d Retinal tomography showing optic nerve head damage in the RE and LE, respectively. e, f Retinography of both eyes with details of the optic nerve head; a particular aspect with multiple excavation notching can be observed (‘bubble notching’). g OCT evaluation revealing the average thickness reduction in both eyes. h Steady-state PERG analysis showing an amplitude reduction in the RE (blue line) and a very poor signal in the LE (red line).
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Figure 2: Visual field showing diffuse defects with focal central conservation in the RE (a) and total visual field deficit in the LE (b). c, d Retinal tomography showing optic nerve head damage in the RE and LE, respectively. e, f Retinography of both eyes with details of the optic nerve head; a particular aspect with multiple excavation notching can be observed (‘bubble notching’). g OCT evaluation revealing the average thickness reduction in both eyes. h Steady-state PERG analysis showing an amplitude reduction in the RE (blue line) and a very poor signal in the LE (red line).

Mentions: At the observation analysis, both optic discs showed a characteristic aspect with multiple excavation notching that we called ‘bubble notching’, probably due to a glaucoma-like optic disc damage. The visual field presented an extensive and diffuse defect on 360° with focal central conservation in the RE, while total visual damage was reported in the LE. The results of steady-state PERG in the RE were: amplitude 0.29 µV RMS, phase 0.29 pi; and in the LE: amplitude 0.18 µV RMS, phase 1.08 pi. Analysis of the RNFL by OCT showed a significant average thickness reduction of 66.51 and 67.69 μm in the RE and LE, respectively. Retinal tomography evaluation showed the following data in the RE: disc area = 2.518 mm2, cup/disc area ratio = 0.62; and in the LE: disc area = 1.862 mm2, cup/disc area ratio = 0.696. The morpho-functional details are reported in fig. 2.


Bilateral Glaucomatous Optic Neuropathy Caused by Eye Rubbing.

Savastano A, Savastano MC, Carlomusto L, Savastano S - Case Rep Ophthalmol (2015)

Visual field showing diffuse defects with focal central conservation in the RE (a) and total visual field deficit in the LE (b). c, d Retinal tomography showing optic nerve head damage in the RE and LE, respectively. e, f Retinography of both eyes with details of the optic nerve head; a particular aspect with multiple excavation notching can be observed (‘bubble notching’). g OCT evaluation revealing the average thickness reduction in both eyes. h Steady-state PERG analysis showing an amplitude reduction in the RE (blue line) and a very poor signal in the LE (red line).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608614&req=5

Figure 2: Visual field showing diffuse defects with focal central conservation in the RE (a) and total visual field deficit in the LE (b). c, d Retinal tomography showing optic nerve head damage in the RE and LE, respectively. e, f Retinography of both eyes with details of the optic nerve head; a particular aspect with multiple excavation notching can be observed (‘bubble notching’). g OCT evaluation revealing the average thickness reduction in both eyes. h Steady-state PERG analysis showing an amplitude reduction in the RE (blue line) and a very poor signal in the LE (red line).
Mentions: At the observation analysis, both optic discs showed a characteristic aspect with multiple excavation notching that we called ‘bubble notching’, probably due to a glaucoma-like optic disc damage. The visual field presented an extensive and diffuse defect on 360° with focal central conservation in the RE, while total visual damage was reported in the LE. The results of steady-state PERG in the RE were: amplitude 0.29 µV RMS, phase 0.29 pi; and in the LE: amplitude 0.18 µV RMS, phase 1.08 pi. Analysis of the RNFL by OCT showed a significant average thickness reduction of 66.51 and 67.69 μm in the RE and LE, respectively. Retinal tomography evaluation showed the following data in the RE: disc area = 2.518 mm2, cup/disc area ratio = 0.62; and in the LE: disc area = 1.862 mm2, cup/disc area ratio = 0.696. The morpho-functional details are reported in fig. 2.

Bottom Line: Over a 4-year observational period, his visual acuity decreased to 12/20 in the right eye and counting fingers in the left eye.Visual fields were severely compromised, and intraocular pressure values were not superior to 14 mm Hg during routine examinations.In fact, our patient strongly rubbed his eyes for more than 10 h per day.

View Article: PubMed Central - PubMed

Affiliation: Western Eye Hospital, Imperial College, London, UK.

ABSTRACT
In this report, we describe a particular condition of a 52-year-old man who showed advanced bilateral glaucomatous-like optic disc damage, even though the intraocular pressure resulted normal during all examinations performed. Visual field test, steady-state pattern electroretinogram, retinal nerve fiber layer and retinal tomographic evaluations were performed to evaluate the optic disc damage. Over a 4-year observational period, his visual acuity decreased to 12/20 in the right eye and counting fingers in the left eye. Visual fields were severely compromised, and intraocular pressure values were not superior to 14 mm Hg during routine examinations. An accurate anamnesis and the suspicion of this disease represent a crucial aspect to establish the correct diagnosis. In fact, our patient strongly rubbed his eyes for more than 10 h per day. Recurrent and continuous eye rubbing can induce progressive optic neuropathy, causing severe visual field damage similar to the pathology of advanced glaucoma.

No MeSH data available.


Related in: MedlinePlus